Provider Demographics
NPI:1821710740
Name:PAULON, REBECCA SUE (LADC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:PAULON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-0547
Mailing Address - Country:US
Mailing Address - Phone:651-775-9804
Mailing Address - Fax:844-364-7181
Practice Address - Street 1:6448 MAIN STREET
Practice Address - Street 2:SUITES 1 AND 3
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056
Practice Address - Country:US
Practice Address - Phone:651-775-9804
Practice Address - Fax:844-364-7181
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303412101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)